NHS Health Check E-bulletin - March 2017 edition

Foreword by Professor John Newton, Chief Knowledge Officer, PHE

Over the past 20 years we have seen considerable gains in life expectancy, largely due to reductions in deaths from cardiovascular disease and cancer. While this is a great achievement, it highlights the lack of similar improvements in the number of years spent in ill health due to these and other non-communicable diseases. This has led to an inevitable increasing burden on the health and social care system, which is beginning to appear unsustainable without more direct action on prevention.

The UK Government, Public Health England and NHS England are all committed to tackling this burden through population and individual prevention approaches. The NHS Health Check programme is a world leading example of putting this commitment into practice on the scale required to really make a difference.

However, despite being underpinned by a comprehensive evidence base on the effectiveness of its component parts, and by National Institute for Health and Care Excellence (NICE) recommendations, there has been very little direct evidence on the effectiveness of comparable programmes, which has understandably led to a degree of criticism and scepticism.

In 2014, PHE established the NHS Health Check Expert Scientific and Clinical Advisory Panel (ESCAP) explicitly to keep the evidence on the NHS Health Check programme under review, and we have seen a slow but steady growth in the literature on the programme, including the publication of two landmark national studies in 2016.

To consolidate the learning so far and to ensure a systematic view of the available evidence, ESCAP recommended undertaking periodic rapid syntheses of published evidence, and the first of these has now been undertaken by the University of Cambridge and RAND Europe.

The results are discussed in detail in a recent report from ESCAP, alongside important recommendations for practice and research. There is some positive news on the programme’s impact and reach, but also some clear limitations in the quality and scope of available research.

I commend this report to all those working to commission and deliver the NHS Health Check programme, both locally and nationally, as the first systematic look at what the contemporary evidence tells us about NHS Health Checks and an important step forward in the history of this landmark programme.

The findings are limited by the research base but are nevertheless more than sufficient in many areas to be used to improve delivery and impact on the ground. These early findings provide us with a measure of confidence that the programme is achieving its objectives while also highlighting areas for further development and study. In the spirit of continuing this journey of learning and improving I would like to encourage everyone reading the report to consider how you can put its recommendations into practice.

With thanks to Katherine Thompson, Dr Matt Kearney, Professor John Deanfield, Dr Zafar Iqbal, Professor John Newton and Dr Felix Greaves in preparing the ESCAP report on behalf of the NHS Health Check Expert Scientific and Clinical Advisory Panel.

Operational update by Jamie Waterall, National Lead, Cardiovascular Disease Prevention & Associate Deputy Chief Nurse

Last month we hosted our 4th NHS Health Check conference, which was held in Manchester. I want to thank the 400 delegates, speakers and exhibitors who joined us on the day. Those delegates who completed their evaluation forms considered this to be our most successful event to date, with 92% of delegates rating the event as excellent or good. We have developed a short video from the conference and have provided access to all presentations on our programme website to allow colleagues to continue to benefit from these excellent materials. At the conference we launched two new patient videos, showcasing personal experiences of the NHS Health Check.

Last month, we published our latest version of the NHS Health Check Best Practice Guidance. This update includes a number of minor changes, including new recommendations related to the diabetes risk assessment included in the programme. We know that colleagues value this resource and we welcome your feedback on the publication on an ongoing basis. If you would like to provide feedback on this publication, this can be done by contacting our national team at nhshealthchecks.mailbox@phe.gov.uk.

Last month we published the latest official statistics on the NHS Health Check programme, which shows that since April 2013, over 10.8 million people have been invited and 5.2 million people have received a check. This makes the NHS Health Check one of largest public health programmes of its kind both here in England and globally. We should therefore congratulate all those who are working hard to deliver this important prevention programme. There is clearly more that can be done to improve both uptake and quality of the NHS Health Check, which was emphasised in our Expert Scientific and Clinical Advisory Panel report on the latest evidence pertaining to the programme.

Given the importance of this prevention programme, PHE will be prioritising our support to local teams over the coming year. Our Chief Executive, Duncan Selbie has recently written to all local authority chief executives to share to share the latest evidence findings and to note our offer of support in improving local implementation.

Finally, I would like to remind colleagues that we regularly host webinars on cardiovascular disease prevention topics, which are free to attend and easily accessible. If you would like further information on our programme of webinars, this can be accessed via our programme website.

NHS Health Check total eligible population

As we enter a new financial year it is time to revise NHS Health Check five year eligible population figures. The new values have been calculated by PHE using the latest available Office of National Statistics data (mid-2015 population estimates) for each area minus the estimated number of people on existing disease registers.  To estimate the number of people on existing disease registers and therefore not eligible for a NHS Health Check, the age and sex specific weightings used in the NHS Health Check Ready Reckoner tool were applied to local population.

If local authorities are able to identify their eligible population from local general practice clinical systems or have undertaken a more accurate assessment of their eligible population, PHE will consider a revised figure. 

Evidence on how revised eligible population figures were calculated must be provided to PHE. Requests will be considered by a sub-group of the NHS Health Check Data, Intelligence and Information Governance group. 

Jamie Waterall wrote to the Directors of Public Health requesting that any revision to their NHS Health Check total eligible population for 2013-18 is returned to the national NHS Health Check team by the deadline of 21 April 2017.

The form should be signed by the Director of Public Health, and returned to nhshealthchecks.mailbox@phe.gov.uk.

If you need a copy of the eligible population estimates produced by PHE or if you need a copy of the form, please email nhshealthchecks.mailbox@phe.gov.uk

You do not need to do anything if you are happy with the latest estimates calculated by PHE.

Assessing risk of type 2 diabetes

The 2017 update to the Best Practice Guidance recommends that a validated tool is used to assess the risk of type 2 diabetes as part of an NHS Health Check. To help local authorities understand how different validated risk assessment tools perform PHE has published a comparator tool. This provides an illustration of the number of people in the local population identified at risk of diabetes for each of the tools, as well as estimates for the number of people each tool would identify with non-diabetic hyperglycaemia and type 2 diabetes. The comparator tool is intended to help inform local decisions on which validated tool to use.   

Good Practice Examples : South West Region

Enhanced NHS Health Checks in Bristol

Bristol City Council has been commissioning a Healthy Living Consortium to deliver an enhanced outreach service this year.   The aim is to offer NHS Health Checks as a more convenient, flexible service and increase the reach of the programme to more “at risk” groups. Targeted groups include “blue collar workers”, those living in areas of multiple deprivation and Job Centres. They have also been running a pilot contacting people who are Council Housing Tenants via telephone and mail outs to invite them to attend community outreach events. The project aims to take a more holistic, person centred approach to delivering the NHS Health Check than is possible in primary care. Results have been encouraging, and they have found that delivery in work based settings have generated more checks per time invested.

Please contact Rosanne.Sodzi@phe.gov.uk if you would like further information about the project

Survey of Health Care Assistants Training Needs

Health Care Assistants (HCAs) across the Swindon, Wiltshire and Bath & North East Somerset area were asked to respond to a training needs survey in relation to delivery of the NHS Health Check Programme in December 2016. 73 responses were received.

When asked what training they had received to equip them to deliver the programme the most common answer was ‘an external course of one day or more’ (63%), followed by attending annual updates locally (47%). Only 33% had received training from the lead nurse in the practice and only 14% had completed online training modules.

The majority reported confidence in delivery of the programme including understanding its aims and knowing what is meant by CVD and the risk factors for it However dementia was the area where the majority (55%) felt not as confident on giving feedback. There were also up to a third of respondents who felt less confident about giving feedback on cholesterol results, awareness of lifestyle support services and the brief intervention on alcohol. The preference for further training was face to face, while the least popular was online training. When asked about barriers to training, time was the most cited barrier with a small number (17%) not sure where to get training and support from.

The NHS Health Check programme has a national competency framework to support providers to evidence competency to deliver the programme. When asked about their awareness of the competency framework the majority (46.5%) were not aware of it. A further 28% were aware but not using it. Only 14% were currently using it and 11% had been signed off as competent using the framework.

As a result of this survey a number of actions will be taken forward, including programme leads in each area will work with CCGs, primary care and the LMC to raise awareness of the national competency framework and increase usage . Furthermore, Wessex LMC will work with programme leads to provide an HCA training day in each area during 2017/18 on cardiovascular disease prevention in response to identified need. 

Please contact Rosanne.Sodzi@phe.gov.uk for further information.